Health Library

Atrial Fibrillation: Should I Take an Anticoagulant to Prevent Stroke?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Atrial Fibrillation: Should I Take an Anticoagulant to Prevent Stroke?

1

Get theFacts

2

CompareOptions

3

YourFeelings

4

YourDecision

5

QuizYourself

6

Your Summary

Get the facts

Your options

Take an anticoagulant medicine to reduce the risk of stroke.

Don't take an anticoagulant. You may try aspirin or do nothing.

Key points to remember

Atrial fibrillation increases your risk of
stroke.
Other things that raise your risk include heart failure, high blood pressure, a previous stroke, and diabetes. Your doctor can help you know your risk. Taking
an anticoagulant lowers that risk.

When you take an anticoagulant, also called a blood thinner, you need to take extra steps to avoid bleeding problems, such as preventing falls and injuries.

Depending on the type of anticoagulant you take, you may have to get regular blood tests and watch how much vitamin K you eat or drink.

If you have a low risk of having a stroke or cannot take an anticoagulant, you may choose to take daily aspirin or to not take any blood-thinning medicine.

Aspirin doesn't
work as well as an anticoagulant to reduce your stroke risk. Like an anticoagulant, aspirin can cause bleeding problems. This risk of bleeding might be lower than the risk of bleeding with an anticoagulant.

Anticoagulants are
medicines that help prevent blood clots. Blood clots can lead to
stroke. These medicines are often called blood
thinners, but they don't actually thin your blood. Instead, they increase the
time it takes for a blood clot to form.

The risk of stroke isn't the same for everyone who has atrial
fibrillation. But on average, people who have atrial fibrillation are 5 times more
likely to have a stroke than people who don't have atrial
fibrillation.footnote 1 Anything that increases your risk for a disease or problem
is called a risk factor. The more risk factors you have, the greater your
chance of having a stroke.

Anticoagulants can help protect against stroke. Your doctor
may recommend that you take an anticoagulant if you are at high risk for stroke based on
your risk factors.

Your doctor can check your risk of a stroke. Things that can raise your risk include:

When you take an anticoagulant, your blood clots more slowly than normal. This increases your risk of bleeding problems in and around the brain, bleeding
in the stomach and intestines, bruising and bleeding if you are hurt, and
serious skin rash.

Some people can't take anticoagulants, because
they have a higher risk of having a serious problem if bleeding occurs. For example, you may have a higher risk of bleeding if you have uncontrolled high blood pressure, have kidney or liver disease, or drink large amounts of alcohol.

When you take an anticoagulant, also called a blood thinner, you need to take extra steps to avoid bleeding problems, such as preventing falls and injuries. With the anticoagulant warfarin, you also need to have regular blood tests to make sure you are taking the right dose. And you need to watch how much vitamin K you eat or drink.

You will want to weigh the
benefits of reducing your risk of stroke against the risks of taking
an anticoagulant, such as an increased risk of bleeding. For example, each year about 1 to 3 out of 100 people (or 10 to 30 out of 1,000 people) who take an anticoagulant will have a problem with severe bleeding. This means that 97 to 99 out of 100 people (or 970 to 990 out of 1,000 people) will not have a bleeding problem.footnote 2, footnote 3, footnote 4, footnote 5 But these are average risks. Your own risk may be higher or
lower than average based on your age and your own health. For example, your risk may be higher if you have kidney or liver disease.

Anticoagulants lower the risk of stroke in people
who have atrial fibrillation. But how much your risk
will be lowered depends on how high your risk was to start with. Not everyone
with atrial fibrillation has the same risk of stroke. It's a good idea to talk
with your doctor about your risk.

If you have a low risk of stroke or cannot take an anticoagulant, you can either take daily aspirin or not take any blood-thinning medicine. Aspirin can reduce your stroke risk, but it does not work as well as an anticoagulant.footnote 6

Aspirin is an
antiplatelet medicine, another type of blood-thinning medicine. It reduces the risk of blood
clotting by preventing the smallest blood cells (platelets) from sticking
together and making a clot.

Aspirin can cause bleeding problems. This risk of bleeding might be lower than the risk of bleeding with an anticoagulant. Bleeding that is
bad enough to need treatment in a hospital happens in 1 or 2 out of 1,000
people who take aspirin.footnote 7 This means that 998 or 999
out of 1,000 people who take aspirin don't have serious bleeding. But this is an average risk. Your own risk may be higher or
lower than average based on your own health. Talk with your doctor about your risk of bleeding with aspirin or with an anticoagulant.

January CT, et al. (2014). 2014 AHA/ACC/HRS Guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation, published online March 28, 2014. DOI: 10.1161/CIR.0000000000000041. Accessed April 18, 2014.

January CT, et al. (2014). 2014 AHA/ACC/HRS Guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation, published online March 28, 2014. DOI: 10.1161/CIR.0000000000000041. Accessed April 18, 2014.

Ruff CT, et al. (2014). Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: A meta-analysis of randomised trials. The Lancet, 383(9921): 955–962. DOI: 10.1016/S0140-6736(13)62343-0. Accessed: April 15, 2014.

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Atrial Fibrillation: Should I Take an Anticoagulant to Prevent Stroke?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts

Compare your options

What matters most to you?

Where are you leaning now?

What else do you need to make your decision?

1. Get the Facts

Your options

Take an anticoagulant medicine to reduce the risk of stroke.

Don't take an anticoagulant. You may try aspirin or do nothing.

Key points to remember

Atrial fibrillation increases your risk of
stroke.
Other things that raise your risk include heart failure, high blood pressure, a previous stroke, and diabetes. Your doctor can help you know your risk. Taking
an anticoagulant lowers that risk.

When you take an anticoagulant, also called a blood thinner, you need to take extra steps to avoid bleeding problems, such as preventing falls and injuries.

Depending on the type of anticoagulant you take, you may have to get regular blood tests and watch how much vitamin K you eat or drink.

If you have a low risk of having a stroke or cannot take an anticoagulant, you may choose to take daily aspirin or to not take any blood-thinning medicine.

Aspirin doesn't
work as well as an anticoagulant to reduce your stroke risk. Like an anticoagulant, aspirin can cause bleeding problems. This risk of bleeding might be lower than the risk of bleeding with an anticoagulant.

FAQs

What are anticoagulants?

Anticoagulants are
medicines that help prevent blood clots. Blood clots can lead to
stroke. These medicines are often called blood
thinners, but they don't actually thin your blood. Instead, they increase the
time it takes for a blood clot to form.

How can medicine help if you have atrial fibrillation?

The risk of stroke isn't the same for everyone who has atrial
fibrillation. But on average, people who have atrial fibrillation are 5 times more
likely to have a stroke than people who don't have atrial
fibrillation.1 Anything that increases your risk for a disease or problem
is called a risk factor. The more risk factors you have, the greater your
chance of having a stroke.

Anticoagulants can help protect against stroke. Your doctor
may recommend that you take an anticoagulant if you are at high risk for stroke based on
your risk factors.

Your doctor can check your risk of a stroke. Things that can raise your risk include:

What are the risks of taking an anticoagulant?

When you take an anticoagulant, your blood clots more slowly than normal. This increases your risk of bleeding problems in and around the brain, bleeding
in the stomach and intestines, bruising and bleeding if you are hurt, and
serious skin rash.

Some people can't take anticoagulants, because
they have a higher risk of having a serious problem if bleeding occurs. For example, you may have a higher risk of bleeding if you have uncontrolled high blood pressure, have kidney or liver disease, or drink large amounts of alcohol.

When you take an anticoagulant, also called a blood thinner, you need to take extra steps to avoid bleeding problems, such as preventing falls and injuries. With the anticoagulant warfarin, you also need to have regular blood tests to make sure you are taking the right dose. And you need to watch how much vitamin K you eat or drink.

You will want to weigh the
benefits of reducing your risk of stroke against the risks of taking
an anticoagulant, such as an increased risk of bleeding. For example, each year about 1 to 3 out of 100 people (or 10 to 30 out of 1,000 people) who take an anticoagulant will have a problem with severe bleeding. This means that 97 to 99 out of 100 people (or 970 to 990 out of 1,000 people) will not have a bleeding problem.2, 3, 4, 5 But these are average risks. Your own risk may be higher or
lower than average based on your age and your own health. For example, your risk may be higher if you have kidney or liver disease.

How well do anticoagulants work?

Anticoagulants lower the risk of stroke in people
who have atrial fibrillation. But how much your risk
will be lowered depends on how high your risk was to start with. Not everyone
with atrial fibrillation has the same risk of stroke. It's a good idea to talk
with your doctor about your risk.

What can you do instead of taking an anticoagulant?

If you have a low risk of stroke or cannot take an anticoagulant, you can either take daily aspirin or not take any blood-thinning medicine. Aspirin can reduce your stroke risk, but it does not work as well as an anticoagulant.6

Aspirin is an
antiplatelet medicine, another type of blood-thinning medicine. It reduces the risk of blood
clotting by preventing the smallest blood cells (platelets) from sticking
together and making a clot.

Aspirin can cause bleeding problems. This risk of bleeding might be lower than the risk of bleeding with an anticoagulant. Bleeding that is
bad enough to need treatment in a hospital happens in 1 or 2 out of 1,000
people who take aspirin.7 This means that 998 or 999
out of 1,000 people who take aspirin don't have serious bleeding. But this is an average risk. Your own risk may be higher or
lower than average based on your own health. Talk with your doctor about your risk of bleeding with aspirin or with an anticoagulant.

Why might your doctor recommend taking an anticoagulant?

Your doctor may advise you to take an anticoagulant if:

Your risk of stroke is high and an anticoagulant is the best
treatment for you.

You are willing and able to take the medicine as directed. This includes taking care to prevent falls and getting regular blood tests if needed.

2. Compare your options

Take an anticoagulant to
reduce the risk of stroke

Don't take
an anticoagulant

What is usually involved?

You take a pill once or twice a day.

If you take warfarin, you will have regular blood tests to make sure that you are taking the
right dose.

If you take warfarin, you will try to eat and drink about the same amount of vitamin K each day.

You'll need to let your doctor know of any new medicines you start taking while you are taking an anticoagulant.

You take aspirin
every day, or you do not take any blood-thinning medicine.

What are the benefits?

Anticoagulants lower the risk of
stroke in people who have atrial fibrillation.

Aspirin may lower the
risk of stroke in people who have atrial fibrillation. But aspirin
doesn't work as well as anticoagulants to reduce stroke risk.

You don't need regular blood tests to check the medicine dose, as you do with warfarin.

You don't have to watch how much vitamin K you eat or drink, as you do with the anticoagulant warfarin.

What are the risks and side effects?

Anticoagulants increase your risk of bleeding problems.

Anticoagulants lower
your risk of stroke, but you could still have a stroke.

Aspirin increases your risk of bleeding problems. This risk of bleeding might be lower than the risk of bleeding with an anticoagulant.

If you
have atrial fibrillation and don't take any medicine, you might have a
stroke.

Aspirin may reduce your risk, but you could still have a stroke.
Your risk of having a stroke is higher than it would be if you took an anticoagulant.

Personal stories

Personal stories about taking anticoagulants

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I have other risk factors for stroke besides atrial fibrillation. My doctor and I decided that it is important for me to take an anticoagulant to help reduce my risk for having a stroke."

— Monty,
age 72

"My doctor says I'm healthy and that my stroke risk is low. I don't want to take an anticoagulant, but I would like to do what I can to lower my stroke risk. I think I'll stick with aspirin for now."

— Juan, age 67

"I am not overly concerned about bleeding problems from taking a blood thinner, and I'm motivated to follow the instructions to take it as directed."

— Martha, age 64

"I have a bleeding ulcer that I am caring for, so I can't take an anticoagulant."

— Geraldo, age 52

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take an anticoagulant

Reasons not to take an anticoagulant

I worry about my risk of stroke.

My risk of stroke is low.

More important

Equally important

More important

I'm confident that I can take an anticoagulant as directed.

I'm worried that I can't take an anticoagulant as directed.

More important

Equally important

More important

Lowering my risk of stroke is more important to me than the risk of a bleeding problem.

I'm more worried about my risk of a bleeding problem than my risk of stroke.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking an anticoagulant

NOT taking an anticoagulant

Leaning toward

Undecided

Leaning toward

5. What else do you need to make your decision?

Check the facts

1.
If you have atrial fibrillation, are you at higher risk of stroke than someone who doesn't have it?

January CT, et al. (2014). 2014 AHA/ACC/HRS Guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation, published online March 28, 2014. DOI: 10.1161/CIR.0000000000000041. Accessed April 18, 2014.

January CT, et al. (2014). 2014 AHA/ACC/HRS Guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation, published online March 28, 2014. DOI: 10.1161/CIR.0000000000000041. Accessed April 18, 2014.

Ruff CT, et al. (2014). Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: A meta-analysis of randomised trials. The Lancet, 383(9921): 955–962. DOI: 10.1016/S0140-6736(13)62343-0. Accessed: April 15, 2014.

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

January CT, et al. (2014). 2014 AHA/ACC/HRS Guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation, published online March 28, 2014. DOI: 10.1161/CIR.0000000000000041. Accessed April 18, 2014.

This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. Learn how we develop our content.